Using the Rothman Index to Lower Repeat Hospitalization Risk

Diagnostics and Procedures The Rothman Index (RI) identifies a patient's condition in real time, with an easy-to-understand composite score. Duncan Finlay, M.D., shares his thoughts on the powerful tool.

Duncan Finlay, M.D.

Chief Medical Officer of Alive Sciences

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MEASURING PROGRESS: The Rothman Index, a summary of a patient's current clinical condition, is a powerful tool for early detection of patient changes.

MP: How has the Rothman Index revolutionized healthcare?

Duncan Finlay: The Rothman Index is a patented early-warning system that uses more than 50 unique healthcare measures from a patient’s electronic medical record (EMR) — including a patient’s vital signs, clinical assessments, and lab results — to create one easy-to-read numerical score. That score, which can be plotted graphically, enables healthcare professionals to spot and react to subtle changes in a patient’s condition before they lead to life-threatening issues.

In skilled nursing homes, assisted living facilities and other residential care settings, the Rothman Index provides vital information to managers, helping to determine the proper level of care for individual patients, adjust staffing resources based on acuity, and improve oversight of the nursing staff.

It was the tragic death of Florence Rothman in 2003 that led to development of this innovative software technology. She received a routine heart-valve procedure at a Florida hospital, but died four days after discharge from a relatively common and normally treatable complication that went unnoticed.

Her medical team missed her diagnosis only because they lacked the tools to identify subtle trends in her health. Had those trends been identified as they happened, they could have saved Florence’s life.

To prevent other patients and their families from going through the same ordeal, Florence’s sons, Michael and Steven Rothman—an engineer and a scientist skilled in data analysis—developed an early-warning system using existing EMR data they named the Rothman Index.

MP: How can the Rothman Index cut costs while improving quality of care?

DF: The goal of the Rothman Index is to help providers monitor a patient's health throughout the continuum of care, helping to avoid costly emergency room visits and hospitalizations, while ensuring that the patient receives quality care at the most appropriate level. The Rothman Index score is universal—it can be used to assess patients in any number of non-acute healthcare settings, such nursing homes, assisted living communities, and hospice organizations, as well as patients enrolled in home healthcare.

This innovative tool helps providers cut costs and improve the quality of care in several ways. By identifying subtle changes in a patient's medical condition, the Rothman Index allows caregivers to intervene before a costly hospital admission is necessary. For example, a patient's medication or rehabilitation protocol could be adjusted by a home health care team or a primary care physician. That early intervention also holds the key to improving the quality of care, since many medical problems have worse outcomes when treatment is delayed.

Second, the Rothman Index helps hospitals identify patients who have a high risk of readmission. That's a key consideration since reducing unplanned hospital readmissions within 30 days of discharge is a national priority in healthcare.

Nursing facilities can use the Rothman Index to evaluate the condition of the patient before admission and as a post-discharge tool to track the patient's condition after leaving the facility. It provides guidance on readmitting a patient to the facility within 30 days of discharge, possibly avoiding readmission to the hospital. It can also provide support for outpatient rehabilitation to increase the patient's functionality and lead to a higher quality of life.

MP: What is an issue with EHR that you think needs to fixed?

DF: Because electronic medical records (EMRs) typically contain massive amounts of data, it is very difficult for clinicians to determine what information is meaningful and what is not. In most cases, physicians must scroll back and forth through multiple screens in order to review different sets of data, such as recent laboratory tests or radiology results. In other words, physicians find it hard to "see the forest for the trees."

"The Rothman Index enables healthcare organizations throughout the continuum of care to deliver a higher quality of care without having to invest heavily in additional staff, resources, and training."

That problem is intensified in individuals with chronic conditions such as heart disease, diabetes, asthma or hypertension. Those patients may be taking several different medications prescribed by different physicians. They may require frequent laboratory tests or nursing assessments at home, in a skilled nursing facility or in a hospital. The result is that clinicians find it very difficult to determine the patient's overall condition from a brief review of the EMR.

MP: How does the Rothman Index provide a solution to these problems?

DF: Providing an easy-to-see picture of a patient's current medical condition – and how that has changed over time – is a key step forward in helping clinicians make well-informed treatment decisions, improving the quality of care to the patient. The Rothman Index also allows clinicians to detect subtle health declines in patients, reducing the likelihood of potentially life-threatening medical errors.

In addition, this tool enables healthcare organizations throughout the continuum of care to deliver a higher quality of care without having to invest heavily in additional staff, resources, and training.

The Rothman Index is already in use in more than 30 hospitals, including top-ranked academic medical centers like Yale New Haven, University of Pittsburgh Medical Center, Seattle Children’s Hospital and University of Florida Health Shands Hospital, and has been validated in numerous studies.

Now, the Rothman Index is being offered to retirement centers, skilled nursing homes, assisted living facilities, nursing and rehabilitation centers, hospices, home healthcare agencies, PACE programs and any providers who care for patients after discharge from an acute-care hospital.